Fracture Liaison Services

Baroness Merron Excerpts

Monday 6th July 2026 Lords Chamber

[Lord Black of Brentwood]

To ask His Majesty’s Government what progress they have made in delivering on their policy to ensure universal coverage of Fracture Liaison Services in England by 2030, including implementation plans, timelines and milestones for rollout.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, our 10-year health plan committed to rolling out fracture liaison services nationwide by 2030 and outlines our vision for a more devolved health service. We have cut the number of NHS planning guidance targets from 130 in 2022 to 18 in 2025, and that has given local leaders greater flexibility to adapt and serve local needs. Expectations have been set through the new women’s health strategy that ICBs prioritise community-based models when commissioning new fracture prevention services.

[Lord Black of Brentwood (Con)]

My Lords, I apologise to the Minister for bringing her back yet again to this issue. However, it is now two years since the former Secretary of State said that a national fracture liaison service rollout would be one of the Government’s first actions in office. Two years on, we are still waiting for something—for anything—to happen, and people have died as a result. I have two questions for the Minister. First, does she really believe, in the light of all the evidence she has been given, that it is still possible to achieve universal coverage by 2030? Secondly, if she does, do the Government have funding to make it happen and a timetable and implementation plan which she will publish? If the answer to either of those questions is no, would it not be better to be honest and say that the Government have dropped their commitment?

[Baroness Merron (Lab)]

The noble Lord does not need to apologise for raising this extremely important matter. I am grateful for his campaigning on this, as I am to other noble Lords. There has been a lot of progress. In answer to his first question, I believe that it is possible, not least because all but two ICBs in the new, reconfigured groups have fracture liaison services already, with some having more than one. With respect to his specific request, as with other policies, I cannot give him exactly what he asks for, but I have already referred to some of the Government’s actions. We are looking, through the UK National Screening Committee, at screening women for osteoporosis, and a public consultation is about to start. We are cutting waiting times, and we have expanded community diagnostic centres and DEXA scanners. These, along with a whole range of other measures, show real commitment to tackling the matter that the noble Lord rightly raises, which affects lives and costs lives.

[Baroness Pidgeon (LD)]

My Lords, people from deprived areas have a 25% higher risk of fractures, spend longer in hospital recovering and die in greater numbers after hip fractures. The rollout of fracture liaison services is important to help tackle health inequalities. The Minister mentioned 2030, but how can this be rolled out faster to make sure that we help all these communities?

[Baroness Merron (Lab)]

We have rolled this out further, as we inherited a more limited coverage of fracture liaison services than we have currently, and we are looking at how to improve access. As I said to the noble Lord, 23 out of 25 ICBs have at least one fracture liaison service. We will push this forward through various means, including the Best Practice Guide for NHS Frailty Pathways, which recommends comprehensive neighbourhood-level frailty plans, and the modern service framework, to mention a couple of ways. I have to emphasise that this is about a complete change in the delivery of NHS services, from which fracture liaison will greatly benefit.

[Baroness Lane-Fox of Soho (CB)]

My Lords, I declare an interest as a patron of Day One Trauma Support and as someone with a relatively high knowledge of fractures. How does the Minister expect the new fracture liaison services to embed charities and other organisations on a fully funded basis, as they are vital in working alongside the health service to make sure that rehabilitation goes smoothly and that people from all backgrounds have the best chance of recovery success?

[Baroness Merron (Lab)]

That is absolutely key, as the noble Baroness says. We have to look at the way that we are working. I emphasise again that we are looking at how we can roll out the modern service framework, which will really push this forward. That will involve full consultation with the groups that the noble Baroness rightly mentioned. She spoke about funding. I cannot give specifics without knowing them, but we will be further delivering this already improved service, as well as taking other supportive actions. These include asking local authorities to include menopause in the NHS health check later this year, which will help greatly with earlier identification.

[Lord Winston (Lab)]

My Lords, the noble Lord asks a very important Question. Can the National Health Service make sure that there is a checklist for all fractures, just as an aircraft pilot does when he is taking off? There are numerous examples in the NHS—I speak from personal experience—of patients not being screened for bacteria before they go down to theatre. That should be a routine check. Further, it is very common for patients to be discharged from hospital when there is a lack of liaison between the hospital and local services. Sometimes, a wound may not be dressed for several days until somebody visits, where there is a risk of bone infection. This is a very serious and common problem.

[Baroness Merron (Lab)]

I understand my noble friend’s point. He referred to checklists. Requirements are in place; I believe he is suggesting that they are not always followed, so I will certainly pick that up. As we move towards a neighbourhood health service, I feel ever more confident that we will attain the right standard of care, along with cutting waiting times. For example, we will make sure that, by 2028-29, for the first time, 80% of community health service activity should take place within 18 weeks. That has not been the case thus far.

[Baroness Chisholm of Owlpen (Non-Afl)]

My Lords, there seems to be a problem for men suffering from prostate cancer, who are also likely to get osteoporosis. Last week, my noble friend and I heard from a consultant neurologist who said that there is not a joined-up approach going back to primary care. The GP should be aware that these people are more likely to have fractures, but they are quite often having these fractures without having been told that that is a possibility, and they are not then getting the care that they need. We need a bit more joined-up thinking, if that is possible.

[Baroness Merron (Lab)]

I understand that point well and I am grateful to the noble Baroness for raising it with me separately. Similar to my response to my noble friend, I will gladly follow that up.

[Lord Kamall (Con)]

My noble friend Lord Black specifically asked about fracture liaison services implementation plans, timelines and milestones on progress towards universal coverage in 2030, to which the Government have committed. To double-check, does the Minister agree with the principle that there should be a published implementation plan, and that timelines should be published and annual milestones set?

[Baroness Merron (Lab)]

I am sure noble Lords would welcome that, and I have heard that call in here, but the noble Lord will know that that is not something we do with every single policy; rather, we take the steps to actually make them happen. The commitment and progress are there, and that will continue.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, unfortunately, at the moment, progress has almost flatlined—I think it will take 38 years to get to the 2030 target. My noble friend said to me on 9 June that the Government have not set milestones. If there are not such milestones as those just referred to, how is the department monitoring this, and will it speed up to reach its own target?

[Baroness Merron (Lab)]

As I have said, delivery will be through ICBs. Of the new clusters, we know that only two do not have fracture liaison services. As my noble friend is very aware, ICBs are held to account through NHS England. Of course, when we make a change through the NHS Bill, that will come within the department. There are many ways we drive progress, including cutting waiting times, opening new community diagnostic centres, investing in DEXA scanners and upping the game on osteoporosis screening, as well as on medication and research. In all these ways, we are contributing to the development of the service that I know my noble friend seeks.

National Maternity and Neonatal Investigation

Baroness Merron Excerpts

Monday 6th July 2026 Lords Chamber

[Baroness Pidgeon (LD)]

My Lords, this is another week and another traumatic and difficult-to-read report about the state of maternity services. Behind it are thousands and thousands of women and families deeply affected by these service failures. I thank them all for their contributions to this report, as well as the noble Baroness, Lady Amos.

Women are not being listened to, heard or believed, with serious consequences for safety and quality of care. Racism and discrimination are embedded throughout the maternity and neonatal system. Services are not responsive to the changing profile of women giving birth and the increase in medical interventions during birth. Antenatal, birth and labour, neonatal and postnatal services are just not joined up. From Somerset to Blackpool, the safety of having a baby has become a lottery. Women are silenced and staff who raise the alarm on unsafe care or systemic discrimination are crushed by a culture of fear. We need to see genuine accountability throughout the NHS and the investment necessary to make Britain the safest country in the world to have a baby.

I have a number of questions for the Minister. I welcome the Government’s commitment to a national maternity commissioner, but can the Minister confirm that this post will go to an independent expert and not a political appointee? Will the Minister reassure us that action will be taken before December, rather than waiting for the taskforce to report on its plans? Will the Government guarantee safe staffing at all hours in every maternity ward in the country, so that no woman has to give birth in an unsafe unit?

This inquiry has, once again, raised the issue of poor bereavement support across the NHS after pregnancy or baby loss. The national bereavement care pathway seeks to resolve this by ensuring high-quality and consistent bereavement care across the UK. The trauma of baby death and pregnancy loss can last a lifetime. Parents’ memories of the care they receive at that moment will stay with them for ever. Good bereavement care can help parents and families navigate their bereavement journey, while poor care can just add to the trauma of loss.

The first moments after a baby dies can be the only opportunity parents have to make memories with their baby, and there is only once chance to get this right. After a baby dies, parents often face really tough decisions, and they cannot make informed decisions about their baby without clear and compassionate communication from healthcare professionals. I therefore ask: will the Government roll out all five national bereavement care pathways, including for miscarriage, and actively monitor implementation across the health system? Will they ensure that suitable bereavement rooms are available in all trusts, not as a “nice to have” but as part of dignified trauma-informed care? This would be a step change for so many families.

There is so much more I could say on a topic that has shocked us all. All families, wherever they live and whatever their ethnicity, must be supported to have their babies safely. This has clearly not been the case for too many years. This is the point where things must change, and I really look forward to the Minister’s response.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, we know—and we can never acknowledge it enough—that women, babies and families across the country are being harmed, traumatised and let down by a broken system. I am grateful to both Front Benches for the way in which they have received this report and for their support, and their acknowledgement of the role we have taken in government.

The noble Baroness, Lady Pidgeon, talked about trauma lasting a lifetime, and that is indeed the case. When I have met women and families who have been affected, that is what has stuck with me: the trauma never goes away. I also accept the correct challenge from the noble Lord, Lord Kamall, that the judgment will be on what has changed, not on what is written. We are very conscious of that, and I am grateful to him for reminding me of it.

Before turning to the helpful questions from the noble Baroness and the noble Lord, I will make a few comments. I too want to express my gratitude to every woman, family member and member of staff who came forward to give evidence to the noble Baroness, Lady Amos, and her team, who heard from thousands of people who showed great courage and determination to share their experiences, painful though they were, and conducted their investigation with immense sensitivity and care. The noble Baroness, Lady Amos, diligently brought together evidence from families, staff, 12 local investigations and all the past reviews, and her review shows systemic, repeated failures by our maternity and neonatal system. It has also given us the opportunity and determination to break that cycle.

As I know your Lordships’ House will agree, it is also important that we acknowledge the very positive role that so many staff and families have played in providing the necessary care.

It was most helpful that some of our immediate actions were acknowledged. But, on top of those immediate actions, some of which have been mentioned today, we have ongoing actions. We have been tackling avoidable brain injuries and maternal deaths through dedicated programmes and packages. We have already begun the expansion of Martha’s rule to all maternity and neonatal units, to give families and patients the right to request a second opinion where there are concerns.

Among other things, we have also introduced a perinatal culture and leadership programme, which is important to develop a safety culture and a learning and support culture for the leadership across all units, and an early warning system to better identify safety concerns. Importantly, because continuity of care is something that has been highlighted a lot, we are providing £10 million of recurrent funding to ICBs for this very purpose, in particular to provide midwifery continuity of care for those women who live in the most deprived neighbourhoods and who are at risk of poor outcomes.

I will do my best to answer the questions asked by noble Lords. The noble Lord, Lord Kamall, asked about the timeline for Leeds and Sussex. Donna Ockenden, who will be chairing those reviews, is currently engaging with the families on terms of reference, which will include timelines. We will not be waiting for the publication of the findings to make changes. As they emerge, those issues will be shared with us, so that we can act.

In answer to the question from the noble Lord, Lord Kamall, the new maternity triage standards will be implemented by June 2027. There must be clear board oversight in place of the operation of the triage system, including regular reviews of waiting times and actions to improve the necessary services. The role and remit of the maternity commission is being urgently considered by the National Maternity and Neonatal Taskforce. The commissioner will co-chair the taskforce, which will drive all the change as well as setting it out.

On workforce pressures, we are not waiting. There is £10.6 million investment funding in an additional 1,000 temporary roles to help newly qualified midwives to join the NHS, which is extremely important. So, we are not waiting for the 10-year workforce plan. However, the taskforce will take into consideration wider work, including the 10-year workforce plan.

With regard to concerns raised by Bill Kirkup about what is referred to as “normal birth ideology”, women have to be able to make the right decision about what is safest and best for them. No woman should ever feel pushed into a particular type of care. The words “normal” and “natural” are perhaps not particularly helpful in this setting. We are talking about vaginal births; what matters is what is best and what is safest, and I am certainly very grateful to Bill Kirkup for all this work.

The noble Baroness, Lady Pidgeon, asked further questions about the commissioner, which were helpful. The selection and appointment process will be considered as part of the process of establishing the role.

Questions were asked on action being taken before December, when the report of the taskforce will be available. As I mentioned, immediate actions are already being driven forward. These actions were already under way over the last two years and as part of the immediate response to the recommendations of the noble Baroness, Lady Amos. Where we can, we have already actioned work, and, where we need further work done, that will be developed over the next few months, at pace.

The noble Baroness raised a good point about the rollout of bereavement pathways, including for miscarriage. We are rolling out all five strands of the national bereavement care pathway. All trusts in England have signed up to implement the core standards of the national bereavement care pathway. That is relevant in this case and, across other areas of bereavement, is of particular concern.

As I draw my remarks in this section to a close, let me give noble Lords a sense of the urgency. The taskforce and its supporting expert reference groups are meeting tomorrow to discuss the findings of both the Donna Ockenden report, on which we had a Statement last week, and the report by the noble Baroness, Lady Amos. Next Tuesday, the taskforce—which is spearheading all this and chaired personally by the Secretary of State—will be meeting to discuss next steps for the action plan. To the questions from the noble Baroness, Lady Pidgeon, about the commissioner’s role, the Secretary of State has already said that he wishes that the maternity and neonatal commissioner will co-chair the taskforce with him. That would be a very welcome move.

I hope that I have dealt with the questions and, more than that, given a sense of the pace and seriousness, as well as the action that I know we all seek.

[Baroness Blackstone (Lab)]

My Lords, I declare an interest as the chair of the Royal College of Obstetricians and Gynaecologists board of trustees. The RCOG desperately wants to see an improvement in the services that mothers and children are getting in maternity. I do not know whether the Minister is aware that some 68% of all clinicians are working hours way beyond their contracts, and 25% of them are talking about leaving the profession within five years because of a fear of burnout. Obviously, everything must be done to prevent that happening. Does the Minister agree that workforce planning is central here, including better integration between the work of doctors in maternity and midwives? There should not be barriers between the two; they should be working in units together and dealing with high-risk cases. In that context, will some decision be made pretty soon about when a redesigned workforce tool will be available for obstetricians in particular? They desperately want to see that as soon as possible and do not want to have to wait maybe as long as a year before an action plan is completed.

[Baroness Merron (Lab)]

My noble friend allows me to say how grateful we are to the Royal College of Obstetricians and Gynaecologists for its continuing work, as we are grateful to our many partners who are committed to driving through change. We are working particularly closely with RCOG in developing routes forward. I agree with the points that my noble friend made. Most NHS maternity staff—and other staff, but we are talking about maternity staff—are providing exceptional care. It must be very difficult for them to hear about and read these findings. Our job is to support them with the right culture and leadership, and to equip them and support them to listen and learn. It is important that we have the right skills mix among consultants, to whom my noble friend refers, and retain them, because they are absolutely key. We will continue to work with RCOG accordingly.

[Baroness Watkins of Tavistock (CB)]

My Lords, like others I recognise the kindness and compassion that the majority of staff in our health service deliver, but as the Secretary of State for Health and Social Care rightly said:

“We must break the cycle of recommendations sitting on a shelf gathering dust”.


The Minister has already made it clear that the reviews currently planned will continue. I wondered whether they might be postponed or cancelled, but, as they are not going to be, will we ensure that we stop looking further and actually implement what is necessary now, in particular more senior midwives on duty at night? As well as employing more midwives, can we look, through the NHS workforce plan, at putting both general nurses and mental health nurses on fast-track midwifery courses so that we have experts in other areas working in midwifery?

[Baroness Merron (Lab)]

I know that the noble Baroness, Lady Amos, made the kind of comments to which the noble Baroness refers. The National Maternity and Neonatal Taskforce will certainly look at all these areas and, as I mentioned, those reviews will continue. I emphasise that we have to bring this cycle to a close. That is exactly why the former Secretary of State commissioned the noble Baroness, Lady Amos, so that we would bring together a coherent, fully informed list of national recommendations. That is indeed what we have, and we have already actioned a number of them. To the points that the noble Baroness made, that work will continue and will not be held up.

[Baroness Adams of Craigielea (Lab)]

My Lords, I will follow on from the excellent question and suggestions from the noble Baroness, Lady Watkins, about specialist nurses being fast-tracked into midwifery. Donna Ockenden’s report found that many student and newly qualified midwives feel they do not have the necessary level of skills to deal with complex cases. What conversations will the taskforce or the commissioner have with the Royal College of Midwives about the training pathway for midwives? Currently, the Royal College of Midwives does not seem to see any need for a return to nurse training.

[Baroness Merron (Lab)]

I am fully aware of—I will put it tactfully—the difference of opinion in this regard. This morning, I was speaking with one of our main advisers, who did not feel it was necessarily an answer to go down the road of midwives being nurses—I know the noble Baroness did not say that—and I bow to that experience, but for me it raises the complexity.

It is important to emphasise a point about which I have been concerned for some time: about a third of student midwives have no role to go to. The noble Baroness is right, but some of it is about basic experience, and nobody can gain experience without putting the years in—that is a fact. That is why getting the new funding, up to £10,000 per post, means we will keep students in the profession and give them the chance to develop the very important expertise to which the noble Baroness refers. Further, having multidisciplinary teams and the right people means that you can manage whatever complexity. There is no way that any one person can deal with all complex cases. Every case has a high degree of individuality, as I know the noble Baroness is aware.

[Baroness Thornton (Lab)]

My Lords, “welcome” is not quite the right term to use about these reports, but they are indeed absolutely essential. I need to declare that I am the maternity lead, as a non-executive member, at the Whittington Hospital, and I will be at the conference as a member of one of the reference groups tomorrow.

Several years ago, when Donna Ockenden produced her first reports, we set up what we called the Ockenden cafes in the Whittington, to which we invited all the multidisciplinary teams, plus mums and patients and people who had been involved over a period of time; it was an enormously valuable and uplifting experience for all of us involved in the maternity care of the women in our area.

However, I want to ask my noble friend about MIS, the Maternity Incentive Scheme, which is now in its eighth year and, as she will know, is designed to get maternity units to improve year by year and through that win some investment in their hospitals. Has that been factored into what might happen next?

[Baroness Merron (Lab)]

I thank my noble friend and all her colleagues for the work they do. We have many examples across the country of first-rate care and great initiatives like the one my noble friend spoke of, which really takes on board one of the problems the noble Baroness, Lady Amos, found: that the voices of women and their families, and of staff, were just not heard or acted on. That is the one thing that comes through.

To the question, would the abbreviation be MIS in this case?

[Baroness Thornton (Lab)]

Yes, MIS.

[Baroness Merron (Lab)]

We have two “MISs” that we often talk about: MHIS and MIS. I will ensure that MIS is considered, but it is probably worth saying that we are already developing a tool for assessing the quality and experiences of care being provided for women using maternity services, through the patient reported experience measure. To the point made earlier by the noble Lord, Lord Kamall, that is one of the ways we will ensure that women and their families can actually see, feel and know the difference.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interest as chairman of King’s Health Partners. In addition to addressing workforce concerns and driving a much-improved culture in the delivery of maternity services, the physical environment in which maternity services are delivered is critically important. These are very frequently delivered in some of the worst parts of the NHS estate in such a way that the holistic nature of the services that need to be provided is not available at a single site. Can the Minister confirm that the NHS capital budget identified for this spending period is going to be protected so that these matters might be addressed?

[Baroness Merron (Lab)]

The noble Lord makes a very accurate observation. Perhaps I can go a bit further than he is asking me, because just last week we announced an additional £41 million of safety funding to improve the estate. That is on top of the £145 million that was previously announced, so that will give a great opportunity to really improve the estate, which is crucial for safety as well as experience.

[Lord Redwood (Con)]

My Lords, my sister died at birth, so I remember well the impact this has on families. What more can the Government and the NHS do to help those families who have lost a baby in such painful circumstances, or who are now bringing up a disabled child as a result of medical difficulty?

[Baroness Merron (Lab)]

I am very sorry to hear of the loss the noble Lord experienced and of the deep effect on his family; I am sure he still lives with that feeling. I think the greatest gift we can give is to reduce the risk of something going in the way that it did in his family, and that we avoid all avoidable risks. That is exactly what this work is about, and that would be the right thing. For those who are affected, I mentioned the bereavement pathways. In terms of support that ICBs arrange across the country, there is a much greater awareness of the need to support people when they need it most.

[Baroness Tyler of Enfield (LD)]

My Lords, both the report of the noble Baroness, Lady Amos, and the Ockenden inquiry identified poor leadership cultures—defensive cultures, dismissive cultures and doctor-knows-best cultures. The noble Baroness already referred to the voices of women and their partners being ignored, particularly when they are complaining of pain. Is the Minister satisfied that the various important recommendations, provided they are implemented and seen through, will fundamentally address and change this culture?

[Baroness Merron (Lab)]

It is a challenge to take on a deep-rooted culture, but we are doing that and it will require action at every level, without doubt. The main thing, as the noble Baroness said, is putting women, babies and their families at the heart of care. This has not been the case. NHS England’s chief executive brought all trust chief executives to London on the day the report was published to discuss the urgent actions trusts can take on this and to focus on the next 100 days. All perinatal leadership teams have also completed a culture and leadership programme, which I believe will strengthen collaboration across maternity and neonatal services. Those are just two of the actions we will take, but this is absolutely fundamental to all the system changes.

[Lord Winston (Lab)]

My Lords, I listened to this short debate with a bit of amazement. We are looking at the end results, but we need to look a little further up the channel. My noble friend Lady Blackstone touched on a very important point, as indeed did the noble Baroness, Lady Pidgeon, which is much more crucial than we may perhaps understand. First, as has been said, these people come to hospital not to access maternity services but to have a baby. They are not ill. That is different from the rest of the NHS, even though they are in the NHS. What we are partly seeing here is a cultural situation that is a problem throughout the NHS, not just in maternity services. It is bad in maternity services for the obvious reason that, in the main, these people are healthy, although some are not terribly fit. We are losing the plot a bit.

For example, the noble Baroness, Lady Pidgeon, said that there is a need for much better psychological support, and I agree. We tend to forget that a woman who is having a baby, even a normal baby who is fully alive, is losing a life within her uterus. She feels a loss when that happens. It may not be expressed as a loss—it is expressed as happiness—but it is an extraordinary change of feeling, which psychiatrists know is very common in maternity. We forget that this affects not just women but men as well.

We also sometimes assume, as we have done in this report—certain things are obvious—that it is much better not to have a caesarean section. That has been suggested, but it turns out that a caesarean section is safer than a vaginal delivery, if you want to be absolutely safe. This has been shown through various studies. I am not advocating caesarean section, of course, but I am pointing out that we sometimes deplore it when it may actually be a useful thing to do.

We have to understand that we are looking at not a broken service but a service under great stress, and we have to deal with that. The noble Baroness, Lady Blackstone, pointed out that its manning is very inadequate. It needs to be a consultant-led service and people have to stay in overnight, but there is not always enough conversation between midwives and obstetricians. There needs to be much closer understanding between the two. Above all, the culture should be one of kindness. Kindness is what we must ensure.

[Baroness Merron (Lab)]

I absolutely agree with what my noble friend said about kindness; when we had the Statement last week, we discussed compassion as well. It is disappointing to have to talk about it, because it should be a given, but we have found that it is not. I totally agree that pregnancy is not an illness—I was once quoted as very sharply telling an interviewer that. I am not aware that it is, and it is not, but it is worth restating, in my view. On the role of men, I am very careful to speak about women and families; that is the right thing. I also clarify that, in this Statement, I do not believe anybody is suggesting that one form of birth is preferable to another. I think we would probably all agree that it is about the form that is safest and the right one for the circumstance.

[Lord Patel (CB)]

My Lords, I thank the Minister for the Statement today and the noble Baroness, Lady Amos, for her excellent report. We have many reports now describing the tragedies occurring in maternity services. I hope this report will be the final one before we go back to delivering the best maternity care, as we used to. It was world leading.

I am privileged to have been an obstetrician for nearly 40 years of my life, delivering many thousands of babies—normally, as people refer to it, and by caesarean sections, which are done when there is an indication to do so. We expect the mothers to enjoy normal deliveries, but also to enjoy the delivery when they must have a caesarean section. The greatest privilege I had was to hand a baby to a mother and see the first look on the mother’s face, which is unbelievable; I had the privilege to witness that first-hand, long before partners would see it. It is important that we deliver world-class maternity services and, therefore, that what the task force comes up with has the standards to be delivered. I hope it will be mandatory for those standards to be followed, monitored and audited against. It should be possible, at the mother’s first visit to the antenatal clinic, to have a plan for how her pregnancy will be managed by midwives and obstetricians. It should also be possible to have every maternity unit audited, as used to happen, when things go wrong involving the mother and the families—and to have a plan for how that will be tackled. I hope that will be the answer.

[Baroness Merron (Lab)]

I am sure we were all touched to hear what the noble Lord said. It must be a privilege to have done what he has done, and to have affected so many lives—those at their beginning but also the lives of the women themselves and their families. I am sure we are all grateful to him for that. The work of the task force, and of the expert reference groups—I am so grateful to the noble Lord, as well as my noble friend Lady Thornton, for taking part in one of them—will be to develop a plan of action, not just for how it will happen but for how it will be audited. Perhaps I should say that key to all this is accountability. The Secretary of State himself said in the Statement that what stuck with him from one of the bereaved mothers he spoke to was that accountability is what drives change. Certainly, when it comes to the regulators, that is why we are also taking action to improve.

Children’s and Young People’s Mental Health Services

Baroness Merron Excerpts

Thursday 2nd July 2026 Lords Chamber

[Baroness Tyler of Enfield]

To ask His Majesty’s Government what assessment they have made of the Children’s Commissioner’s report Children’s and Young People’s Mental Health Services: 2024-25, published on 29 June.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, we welcome the report of the Children’s Commissioner. It highlights pressures on children and young people’s mental health services, including rising demand, long waits and the need for better support for those with neurodevelopmental and SEND needs. The findings will feed into our new cross-government mental health strategy, which will focus on prevention, earlier intervention and joined-up support.

[Baroness Tyler of Enfield (LD)]

I thank the Minister for her Answer. The Children’s Commissioner report certainly made plain that children’s mental health services are facing record levels of referrals. The Minister referred to the forthcoming mental health strategy; what we need to see is concrete action in relation to children and young people. Will the Minister reassure me that children and young people’s services will be a priority in the strategy, and will the strategy commit to narrowing the treatment gap for mental health support so that more young people with diagnosable need will be seen by the end of this Parliament?

[Baroness Merron (Lab)]

The mental health of children and young people is completely fundamental to the new strategy, which will cover all ages and be published later this year. But what really needs to be done, as I know the noble Baroness is aware, is to transform mental health care in this country, because the system currently responds too late, is not reducing waiting times and is allowing distress to escalate before intervention. The strategy will work to turn all that around, because we need that system-wide change.

[Lord Patel of Bradford (Non-Afl)]

My Lords, the Children’s Commissioner’s report is a timely reminder that we continue often to respond to crisis rather than preventing it. Twenty years ago, during the passage of the Mental Health Act, Parliament strengthened the safeguards around the admission of children into adult psychiatric wards. That should happen only in exceptional circumstances and only with specialist assessments. At that time, more than 350 children had been admitted, some as young as 11, into adult psychiatric wards. Ten years later, the figure was exactly the same. Can the Minister tell the House what the position is today? Also, what further action is being taken by education and community services to prevent that crisis in the first place?

[Baroness Merron (Lab)]

I do not have the figures the noble Lord very fairly asks for, but I will certainly ensure that they are provided. He will be aware that Parliament recently passed the Mental Health Act, which updated the Mental Health Act to which he referred. The real issue here is about a move to prevention rather than waiting for crisis. That is our whole direction of change.

[Lord Watson of Invergowrie (Lab)]

My Lords, I join my noble friend in welcoming the excellent report from the Children’s Commissioner this week. In her answer to the noble Baroness, Lady Tyler, my noble friend spoke of the need for early intervention and joined-up support. That is one of the issues mentioned in the Children’s Commissioner’s report. Part of that is highlighting the Young Futures hubs, and I know that the Government are committed to introducing 50 of them for 10 to 18 year-olds by 2029. They have a joined-up approach covering everything from education and mental health support to employment advice and crime prevention advice. Can my noble friend give us some idea about when the rollout of the Young Futures hubs will commence?

[Baroness Merron (Lab)]

The first wave of eight, which my noble friend referred to, is under way. It is backed by £4.2 million of investment. The subsequent 42 Young Futures hubs will be rolled out by March 2029.

[Baroness Coffey (Con)]

There was an initiative to have a mental health first aider in every school. What further work has been done to maintain that level in the Minister’s working collaboration with the DfE and local councils?

[Baroness Merron (Lab)]

Important though they are, we are accelerating the rollout of mental health support teams, because we now want to meet a more ambitious target of achieving full national coverage by 2029. We have already made progress. As of March this year, some 60% of pupils in schools and learners in further education were covered by a mental health support team. That is up from 52% the year before. The principle of integration where young people and children are is absolutely right. That is why we are not just investing in but accelerating the coverage of mental health support teams.

[Baroness Finlay of Llandaff (CB)]

Do the Government recognise that, as the report said, school staff often see the antecedents of mental health? Two areas where there is strong evidence are parental alcoholism, with a threefold increase in children considering suicide and a fivefold increase in eating disorders, and repeated physical punishment, particularly of children under the age of seven, resulting in emotional harm, so that simply intervening on the child may be too late, and intervention must be earlier to prevent problems.

[Baroness Merron (Lab)]

I agree with the noble Baroness’s observations. Early intervention is key. That is what our entire focus is on, in the ways we have already discussed, and also on developing a children and young people’s modern service framework because we want to reduce variation and ensure that children get the right support at the right time.

[Baroness Pidgeon (LD)]

My Lord, recent analysis from the charity Young Minds shows that, for the eighth month in a row, the average waiting time from referral to specialist support for young people was more than 300 days, and in the worst case it was two and a half years. Will the Government commit to using the forthcoming cross-government strategy to deliver open-access mental health support in every community for young people up to the age of 25?

[Baroness Merron (Lab)]

The point about age is important and one that we will be considering as we go forward with the mental health strategy. Waiting times are way too long, but there is a particular challenge that we have to meet, which is that some 10% of young people are waiting for an inordinate amount of time, as the noble Baroness said. I was very glad that the report does recognise that increased prevalence is a driver. One in 10 17 to 19 year-olds was in need in 2017 and now it is 1.4. I think that gives some idea of the scale and of why we have to make such a systematic change.

[Lord Kamall (Con)]

My Lords, the report contains a wealth of information and new data on referral patterns, waiting times and outcomes. I welcome the Minister’s response that it will feed into the forthcoming mental health strategy. How is the Minister’s department using this information to target resources and to identify where children’s mental health services are under the greatest pressure, so that, at least in the shorter term, support can be directed to where it is most needed?

[Baroness Merron (Lab)]

What the noble Lord says is absolutely right. That is why the Young Futures hubs, the early support hubs, focus on particular communities. We have taken a view that it is important to go to where need is greatest rather than to where it is easiest to deal with. I should add that we have expanded mental health services in terms of the workforce by delivering 8,500 additional mental health staff three years ahead of schedule. Around 18% of them are directly on children’s and young people’s services.

[Lord Hussain (LD)]

There is a proven, well-documented correlation between broken or highly conflicted families and poor mental health in children and young people. What are the Government doing to support keeping families united?

[Baroness Merron (Lab)]

The noble Lord raises the legitimate point that children’s and young people’s mental health is not just a matter for the health service but requires cross-government thinking on housing, income and other pressures. That is why the mental health strategy is, for the first time, a cross-government strategy led by the Department of Health and Social Care.

Pharmacy Closures

Baroness Merron Excerpts

Wednesday 1st July 2026 Lords Chamber

[Baroness Janke]

To ask His Majesty’s Government what assessment they have made of the impact of increasing numbers of local pharmacy closures on primary healthcare services.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, pharmacies are an easily accessible front door to the NHS and we understand the impact that closures may have. We have increased the community pharmacy budget by £340 million—a 10% uplift that builds on the 19% increase, which was at the time the largest uplift in the NHS. That was delivered in 2024-25 and 2025-26 in order to support pharmacies’ essential role. Recent data indicates that closures have slowed, with 19 net closures in 2025-26 compared with 112 in 2024-25.

[Baroness Janke (LD)]

My Lords, I thank the Minister for her response, but 65% of community pharmacies are now operating at a loss; 45% have been forced to rely on personal savings or remortgaging their own homes just to keep their doors open, mainly to vulnerable people with the highest levels of need. What is the Minister’s response to the fact that individual pharmacists are subsidising essential front-line services out of their own pockets? Given that the closures are hitting deprived communities the hardest, what specific measures is the Secretary of State taking to prevent the creation of pharmacy deserts in areas with the greatest health needs?

[Baroness Merron (Lab)]

We are taking a number of actions on the point that the noble Baroness rightly raises. I have spoken about the uplift on the back of a major uplift in the two years previously. For underserved areas, the pharmacy access scheme provides financial support to pharmacies in areas where there are fewer of them. About 1,400 benefit from the scheme and they receive an average of £1,130 per month. Also on the question that the noble Baroness raised, local authorities have health and well-being boards, which assess whether the local provision of pharmacy services meets the needs of the population. Integrated care boards make decisions on pharmacy openings, and they can directly commission a pharmacy if necessary.

[The Lord Speaker (Lord Forsyth of Drumlean)]

My Lords, the noble Lord, Lord Campbell-Savours, is taking part remotely. I invite the noble Lord to speak.

[Lord Campbell-Savours (Lab) [V]]

My Lords, while we all will welcome this year’s very significant increase in funding, which greatly helps the viability of small chemists, we have a real problem in Cumbria, with its small towns, rural communities and limited chemist availability. Could we go further where the result of non-viability is problems in primary healthcare? Could we allow the remaining chemists greater flexibility and discretion in making changes to the strength, quantity and formulation in prescriptions? This could help to relieve the impact on primary healthcare services.

[Baroness Merron (Lab)]

My noble friend is quite right to identify the very important role that pharmacies play in the move from hospital to community. That is why we are funding the rollout of, for example, independent prescribing from autumn this year. That will build on the success of Pharmacy First and the pharmacy contraceptive service, and provide much more local, on-the-spot care for common conditions. In rural areas, dispensing doctors can dispense medicines to patients who live more than a mile from a pharmacy. Also, online pharmacies can deliver medicines free of charge.

[Baroness McIntosh of Pickering (Con)]

My Lords, I refer to my interest advising the Dispensing Doctors’ Association, and my late father and my brother were dispensing doctors. The Minister will be aware that where there are no community pharmacies, dispensing doctors stand prepared to give vaccinations, such as for meningitis B for students returning to university. Will she make good the commitment by dispensing doctors to dispense meningitis vaccinations to this cohort? It seems to have been overlooked in this case.

[Baroness Merron (Lab)]

We are constantly in discussion with Community Pharmacy England and its organisations about how we develop their role. I am very enthusiastic, as many noble Lords are, about the role that they can play. I was looking at statistics between April 2025 and February 2026 about the millions of clinical services, not just vaccinations, that have been delivered. For example, there have been over 4.7 million flu vaccinations. There is scope for discussion on how we can expand the vaccination programme, but the service provided by community pharmacies is to be credited.

[Lord Kamall (Con)]

My Lords, has the department undertaken any analysis of the characteristics of pharmacies that are most of risk of closure to understand whether geography, deprivation, the ownership model or dispensing volume are the principal drivers? Does she agree that having this data might help the department to target some of the uplift more effectively and prevent closures? Can she update the House on whether the department carries out that analysis?

--- Later in debate ---

[Baroness Merron (Lab)]

I know that the noble Lord is aware of this, but pharmacies are private businesses that open and close for a range of reasons. Sometimes pharmacies close and then reopen. That is why I spoke in my Answer about 19 net closures. It is worth noting, as the previous Government did, that access to pharmaceutical services remains good—80% of patients can access a pharmacy within a 20-minute walk. However, local authority health and well-being boards look at local areas and we have a financial scheme to support the development of pharmacies in underserved areas.

[Lord Tyrie (Non-Afl)]

Has any consideration been given to some relaxation of the rules which restrict the ability of GPs to open pharmacies at their practices, to which the Minister has already alluded? Might it be possible to alleviate this problem by relaxing those rules?

[Baroness Merron (Lab)]

As I have said, we keep this constantly under review, but it is the case that GPs can provide dispensing services in a number of situations. That particularly helps if people live further away from a community facility than is ideal.

[Baroness Nargund (Lab)]

My Lords, I thank my noble friend the Minister for her reassuring reply about the closure of local pharmacies. However, research published in 2025 shows that access to local pharmacies has declined almost four times faster in England’s poorest communities. What assessment have the Government made of the impact of this on health inequalities? What steps will they take to integrate pharmacy services within neighbourhood health centres?

[Baroness Merron (Lab)]

That comes into the category of underserved areas, particularly if there are fewer pharmacies. I disagree with my noble friend about the overall picture in terms of pharmacies; we are supporting them to do more work, and a bigger range of work strengthens their position. It is not necessary to live right near a pharmacy, because of provision by online pharmacies. Finally, I repeat that local authorities can also seek to open pharmacies where there are underserved areas.

[Lord Scriven (LD)]

My Lords, community pharmacy has lost thousands of full-time pharmacists in recent years, and many have been recruited directly to other parts of the NHS that can afford to pay more. What more can the Government do to support community pharmacists to minimise this internal displacement and help keep vital local pharmacies open?

[Baroness Merron (Lab)]

This is an important point and why the refreshed 10-year workforce plan, which we will soon see, will deliver the transformation of the health service, which pharmacists are very much part of. We are also looking to support employers in offering a range of national training opportunities for pharmacists and pharmacy technicians. We need to train and upskill the current workforce, and invest in community pharmacy staff. Pharmacists are very important, but there is a whole team with them. Training will include independent prescriber training, clinical examination skills and training the next generation of education supervisors.

IVF Treatment

Baroness Merron Excerpts

Wednesday 1st July 2026 Lords Chamber

[Baroness Nargund (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and I declare my interests as the lead author of the Lancet insight paper on IVF add-ons and as a board member of the Human Fertilisation and Embryology Authority.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, we are aware of the issues raised in the Lancet article regarding the effectiveness of IVF treatment add-ons. The regulator, the HFEA, provides information to patients on the effectiveness of fertility treatment add-ons through its website. In most cases, there is insufficient evidence to demonstrate that they improve treatment outcomes. The Government are considering a range of proposed reforms to fertility regulation, including the scope of regulator powers to regulate add-ons effectively.

[Baroness Nargund (Lab)]

I thank my noble friend the Minister for her reply. The concern about IVF add-ons is not only that many are unproven and ineffective but also that some can pose serious health risks to patients and unnecessary emotional and financial harm. The HFEA’s current traffic light system is guidance only and the regulator has no enforcement powers, which means that some add-ons with a red rating continue to be offered in clinical practice. Will she consider granting the HFEA interim enforcement powers for the use of red-rated IVF add-ons to protect patients from harm while the wider reforms to the fertility regulatory framework are being developed and implemented?

[Baroness Merron (Lab)]

I recognise the situation that my noble friend describes and note that, while the relevant Act has provided a strong framework for over three decades, the fact is that treatment, science and societal expectations have all evolved very significantly since the last major reform in 2008. It is the case that the Act does not currently provide powers to ban add-ons. We are constantly looking at what we can do while we await and consider legislative change, but that really is the best way forward to tackle this.

[Baroness Pidgeon (LD)]

My Lords, the reality is that patients in England are struggling to access publicly funded IVF, with only two out of the 42 integrated care boards in England complying with NICE fertility guidelines. Can the Minister advise whether the Government are considering following Wales and Scotland in centralising commissioning for IVF rather than the current postcode lottery?

[Baroness Merron (Lab)]

We are not doing that, not least because, as the noble Baroness is aware, we believe that the needs of the local population are best served through local decision-making and through the integrated care boards. That said, I absolutely recognise that access to NHS-funded fertility services is variable, and we are reviewing the situation so that we can determine the next steps. I should emphasise that NHS commissioning organisations are expected to commission fertility services. They do have NICE guidance, which we are supporting them in following.

--- Later in debate ---

[Baroness Deech (CB)]

My Lords, I declare an interest as a former chair of the HFEA. Does the Minister agree with me that we really must get on with modernising the Act, as more and more gaps are revealed? In the meantime, does she agree with me that the HFEA should collect data by asking clinics to supply it? Then it would get firm evidence about what works and what does not. It could then publish the data, and make sure that patients are informed by their clinics, or by leaflets in the waiting room, to go on the clinic website and the HFEA website to get the accurate information.

[Baroness Merron (Lab)]

I would agree with the noble Baroness about the importance of ensuring that those who are considering accessing services—particularly the “add-on services”, as they are referred to—have the full information. The place for that is the HFEA website. The HFEA does make efforts, as do we in the NHS, to ensure that people are guided; however, it will be down to the individual. I absolutely agree with her about the need for reform for the reasons that I said earlier, and that is why we are looking at it.

[Baroness Owen of Alderley Edge (Con)]

My Lords, the HFEA has reported a 44% increase in the number of patients freezing their eggs from 2022 to 2024, yet data shows that very few women return to use those stored eggs and success rates decline with age. Given the frequent promotion of egg freezing to women without adequate reference to these limitations, will the Minister set out what steps the Government are taking to ensure that accurate information is widely available to those considering this procedure?

[Baroness Merron (Lab)]

The noble Baroness is quite right to identify that this is not an insurance policy to be relied on to guarantee a baby in the future, no matter what suggestion there may be to the contrary. It is also worth knowing that, while egg freezing is the fastest growing fertility treatment, it is proportionately still small—comprising about 5% of treatments. To her point, there is a responsibility on fertility clinics to ensure that anyone using their services understands the risks—which I must emphasise—as well as the long-term impacts of any treatment decisions that they make. It is quite right and proper that they do that.

[Lord Hunt of Kings Heath (Lab)]

My Lords, with the abolition of NHS England, ICBs will be given many more responsibilities in the future. However, does the Minister agree that their record on IVF, where they are not following the clear, specific guidance that they have been given, does not induce confidence in ICBs’ performance? Inevitably, Ministers will be drawn to make decisions more centrally. Does the Minister think ICBs understand that the kind of rationing that they undertake at the moment in relation to IVF is utterly unacceptable?

--- Later in debate ---

[Baroness Merron (Lab)]

I do find it unacceptable that people have different access to treatments in the way that noble Lords have described. I would expect that the move through the Health Bill will enable us to have a far more effective means, in all sorts of areas, to ensure that local populations are properly served. That is why we will be bringing the functions of the NHSE into the department. As my noble friend will know, that will ensure that we no longer have duplication and that we have the right resources. I very much expect and want to see adequacy of access and fairness, which is the basic thing in all NHS treatment, to be established in fertility treatment.

[Lord Kamall (Con)]

My Lords, I begin by thanking and paying tribute to the noble Baroness, Lady Nargund, and to her co-authors of this fascinating paper. Clearly, it shows that IVF is an area in which innovation is important but so too is the need for evidence. At a time when add-ons have sometimes quite fancy scientific names such as platelet-rich plasma, embryo imaging or intralipid infusion, it is understandable why patients may feel confused and think that this is a much-needed medical intervention. Are the Government aware of high-quality research into IVF add-ons that would give patients, clinicians and regulators greater confidence about which treatments generally improve outcomes for patients?

[Baroness Merron (Lab)]

All of this is important, not least because noble Lords will have seen in the women’s health strategy that we want to ensure that every woman can access effective fertility services easily and safely. I would certainly agree that there are areas where the fertility evidence base could be strengthened, and we are looking at how we can best support research and data collection, which was another point raised by noble Lords. We are currently working with NHS England, which will become part of the department, because we want to support equitable commissioning but also the right evidence base so that information is properly available. At present, there is scant evidence that many of these add-ons are anything other than optional and not recommended.

[Baroness Gerada (CB)]

My Lords, would the Government consider requiring the HFEA to share data on these inappropriate and harmful add-ons with the General Medical Council so that fitness to practise concerns can be acted on?

[Baroness Merron (Lab)]

It is important that, where there are concerns, they are acted on. Perhaps the noble Baroness, with her experience, has a particular way in which that could be followed up, but certainly the GMC would be expected to take action if there was incorrect and unacceptable practice. I am not suggesting that in respect of add-ons to fertility treatment; I am focusing on the need for fair, equitable, NHS-funded fertility services and ensuring people know that there is not evidence that their chances of conceiving will be improved currently by any of these add-ons that are being offered, which is the worrying situation that we have.

Extreme Heat: Resilience of NHS Infrastructure

Baroness Merron Excerpts

Tuesday 30th June 2026 Lords Chamber

[Earl Russell]

To ask His Majesty’s Government what assessment they have made of the resilience of NHS infrastructure to extreme heat; and what steps they are taking to ensure that NHS buildings are adequately equipped to withstand prolonged periods of extreme heat.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, extreme heat does pose a serious risk to NHS buildings and services. All NHS organisations are required to have effective arrangements in place for adverse weather. We are supporting trusts to target the most critical estates risks with £6.75 billion over nine years, including risks that need to be dealt with in respect of cooling and ventilation; and we are ensuring that new hospitals and new-build neighbourhood health centres have climate resilience embedded in their design from the outset.

[Earl Russell (LD)]

I welcome the Answer from the noble Baroness. Last Wednesday was the London Ambulance Service’s busiest ever day for life-threatening emergencies, and at least six NHS trusts declared critical incidents. Nine in ten of our NHS buildings are ill-equipped to handle heat. The Climate Change Committee’s report, A Well-Adapted UK, argues urgently for solar batteries and cooling across all public buildings, yet Great British Energy’s programme covers only 200 out of 1,200 NHS sites. Therefore, will the Minister commit to ensuring that every hospital has solar battery storage and air-source heat pumps by 2035?

[Baroness Merron (Lab)]

The Government are indeed providing trusts with substantial investment—I mentioned just some of it—in these measures, and that is very much in line with the Government’s net-zero ambitions and intent. We are investing £155 million in solar projects and £400 million in heat decarbonisation grants across the NHS. I emphasise that, looking forward, all NHS new builds and major upgrades will align with the net-zero building standard.

[Baroness Stuart of Edgbaston (CB)]

My Lords, following the Question from the noble Earl, Lord Russell, before we have all those solar systems in place, I urge the Minister to audit major hospital trusts on their back-up power systems, and in particular to ensure that the refrigeration facilities are available continuously for the storage of medicines, life support systems and all the other essential elements that require electricity.

[Baroness Merron (Lab)]

Yes indeed, and I go back to my point about the £6.75 billion estates safety fund, the whole intention of which is to target the most serious risks, such as those the noble Baroness refers to. Vital projects will attract that funding. They include overheating risks such as broken chillers, outdated air-handling units and, if needed, refrigeration—in other words, where there is a need for urgent upgrades.

[Viscount Stansgate (Lab)]

My Lords, last night, here in the House, the Parliamentary and Scientific Committee, of which I am president, held a meeting on the effects of extreme heat in the workplace. During that meeting, reference was made to the fact that, during last week’s heatwave, several MRI machines failed. Will my noble friend extend an invitation to the Physiological Society, which has done a great deal of work on the effects of heat on the human body, and consult it on possible ways these types of events can be avoided?

[Baroness Merron (Lab)]

My noble friend raises an important point. It is important to note that extreme heat particularly affects buildings with poor insulation and limited natural ventilation, which, by their very nature—I am describing many health settings—heavily rely on such measures if there is heat-generating equipment like imaging suites and IT systems. Also, 11% of buildings in the NHS estate are older than the NHS itself, which gives some sense of the scale. We have committed £10.5 million in research funding to develop effective cooling solutions that can be used across the whole system. It may well be that the organisation to which my noble friend refers is part of that, but I will take his suggestion back to the department.

[Lord Kamall (Con)]

My Lords, I am grateful to the Minister for answering the Question of the noble Earl, Lord Russell, on new-build hospitals, but there is clearly a question about existing hospitals and facilities. I wonder what plan or strategy there is, and whether it is written down, to identify hospitals that do critical and time-sensitive procedures, to make sure that they are prioritised when there are extreme heat conditions, and to commission independent hospitals with the appropriate cooling and ventilation systems to allow those critical operations to go ahead.

[Baroness Merron (Lab)]

We are already investing some £30 billion of capital across the NHS estate. I have mentioned the most serious infrastructure risks, which the noble Lord rightly refers to. While we accept the age of the estate and its size—I noted in preparing for this Question that we are talking about the equivalent of 4,000 football pitches—we also have a backlog of maintenance issues, which have grown and grown. We estimate that some £15.9 billion is needed. While there are no easy solutions, we do have a resilience plan not just for overheating but for all threats to resilience arising from temperature. We are also providing the funding—although, to the point the noble Lord makes, it is down to local decision-making—and ensuring that we are assisting the estate across the country to meet the challenges, the priority being those areas that need it most.

[Baroness Pidgeon (LD)]

My Lords, aside from the estate, patients on medications known to cause issues in extreme heat are not always being given specific advice on adjusting use of these during extreme weather and, as a result, have been admitted to hospital. What work is the department doing, particularly given that we have further hot weather coming, to ensure that patients receive the right advice and support to avoid hospital admissions as a result of such hot weather?

[Baroness Merron (Lab)]

The recent heat health alert was the first alert since July 2022. Importantly, the UK Health Security Agency has updated its weather health alert system in order that action can be taken and preparations put in place. It has also expanded its guidance, communications and the training of staff across the health and social care sector, so they can better deal with the challenges.

[Lord Krebs (CB)]

My Lords, I was very pleased to hear the Minister say in response to the Question of the noble Earl, Lord Russell, that all new hospitals and hospital projects in the pipeline will be climate-proofed, and that that will include resistance to extreme heat. However, I would like to ask about care homes. The most vulnerable in society include the elderly—a category to which I admit I belong, along with a number of other noble Lords—and care homes are therefore an important element of protection against extreme heat. What plans do the Government have to ensure that care homes are as well protected from extreme heat as the Minister says hospitals will be in future?

--- Later in debate ---

[Baroness Merron (Lab)]

Clearly it is a different situation, in terms not of climate but of the estate. I know the noble Lord is aware of this, but it is worth pointing out that the social care sector is rather more fragmented and includes the private sector. However, for social care, advice is available about what measures to put in place, along with training.

[Baroness O’Grady of Upper Holloway (Lab)]

My Lords, many workers across many sectors are suffering unbearable temperatures that they are expected to work in, and that is increasing demand on the NHS and its services. Does the Minister agree with the principle that health and safety laws can drive adaptations in workplaces necessary for the health and safety of the workforce, as happened with the introduction of a minimum working temperature? Is it time that we had a maximum working temperature, as the TUC has called for?

[Baroness Merron (Lab)]

I acknowledge the push my noble friend is making. She will understand that the decision she asked me to comment on is not one for my department, but I will certainly draw it to the attention of the appropriate ministerial colleague.

Nottingham Maternity and Neonatal Services

Baroness Merron Excerpts

Monday 29th June 2026 Lords Chamber

[Baroness Pidgeon (LD)]

My Lords, the Statement before us today from the Secretary of State in the other place is distressing reading, as is the report by Donna Ockenden. This review shocks us all to the core and must shake the Government into real action at every level of our health service and its regulation. Staff concerns were dismissed, a board did nothing and regulators failed in their duties. There was a simple refusal to listen to women and their families, causing such loss, trauma, negligence and damage, alongside bullying, organisational failures and the horrendous misplacing of bodies. Words just cannot express this horror. What brave and resilient families to keep fighting for justice; I thank them all.

I heard the deeply moving testimony at the press conference last week about the mental health legacy for bereaved parents. One explained how she had lost all trust in the NHS and had the constant, triggering experience of having to engage in her daily life with the organisation she holds responsible for the loss of her baby. It is hard to imagine.

This review, and the upcoming wider review from the noble Baroness, Lady Amos, must draw the line. This has to stop. Mothers, babies, children and families must have confidence that they will be provided with first-class maternity services, wherever they live in our country. There must be quality services that meet their needs whatever their age or background, with respect and dignity at the heart.

I welcome the taskforce, chaired by the Secretary of State. It will be crucial to ensuring the implementation of recommendations at every trust and to ensure that whistleblowing throughout the NHS works. An independent patient voice must remain part of our health service to help hold NHS trusts to account. We will revisit this point with the NHS Bill later this year.

I understand that, in 2018, over 50 members of staff wrote to the chair of Nottingham’s board, stating plainly that there were significant safety concerns. The letter was not even discussed by the board—it went to a sub-committee and was buried. In 2023, the chief executive found that the trust had never formally investigated staff shortages. I cannot get my head around this, as someone who has sat on many different boards over the years. This is not good practice. I therefore ask the Minister what urgent work the Government are undertaking to assess the competence of NHS trust boards. What changes may take place to strengthen them and to ensure that they carry out their serious role and responsibilities thoroughly and robustly?

The Government must also take action to strengthen whistleblowing powers in the NHS. My Liberal Democrat colleagues in the other place have tabled amendments to the Health Bill which would provide new powers for coroners and medical examiners to report suspected health failings. Will the Government look to support those amendments to strengthen whistleblowing in the NHS?

Finally, families need to have confidence in their local maternity services, and those services need to all be at the highest standard. Will the Government commit to a maternity rescue package to deliver this, including one-to-one midwifery care for every woman in labour and consultant obstetricians present 24/7 on every labour ward?

A big step change is needed to transform maternity services across the country that every family and every individual can have confidence in. I look forward to the Minister's response.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, we find ourselves deeply affected, as we have heard from both Front Benches. I am grateful for the tone and for the acknowledgement of the experiences of bereaved and harmed families who are at the absolute centre of this. The noble Baroness, Lady Pidgeon, said that she could not get her head around many of these things; I am sure we are all in agreement on that. I share the views of both Front Benches. I am grateful for the support for action. I absolutely agree with the noble Lord, Lord Kamall, that there is only one test: action. As the noble Baroness, Lady Pidgeon, said, it is also about confidence and step change. We all want to get this right. It is not recent; it is not isolated—as both Front Benches identified. It should not be the case that those who are bereaved and harmed have had to show such courage and determination. This is an impossible circumstance that people are in. The noble Lord, Lord Kamall, said that people understandably often do not wish to add to their distress. The fact is that women, babies and families have all been terribly let down, not as a one-off but by a system—a system that failed to listen, failed to be transparent and, to make it even worse, failed to provide the truth when things went wrong. We are looking at 13 years, since 2012. This is a sustained approach that was totally unacceptable.

On behalf of the Government, I want to say how deeply sorry I am, and the Government are, for what every family has suffered and for those who have been affected. I also want to thank parents and families for their courage and determination for sharing their experiences. Without that, Donna Ockenden and her team—to whom I express great gratitude—could not have done the work that they did. They have been diligent; they have shown compassion and great detail, and it will make a difference.

To the noble Lord, Lord Kamall, I can say that, certainly, the Government are going to deliver a clear and deliverable plan by the end of the year. As the noble Lord and the noble Baroness have asked for, these will indeed be system-wide improvements, so that everyone can have full confidence across maternity and neonatal services—and, yes, it will have milestones and transparency. How will this be done? The noble Baroness, Lady Pidgeon, has spoken about the taskforce. That is important. It is personally chaired by the Secretary of State. There is a very good reason for that—to give the absolute authority of his office. I am the deputy chair of that taskforce. It brings together many groups, including through the expert reference groups, but, crucially, it includes affected families and Michelle Welsh, MP for Sherwood Forrest, who would describe herself as someone who has been harmed in this terrible catalogue of heartbreaking experiences. She is our first appointed maternity adviser to the Secretary of State.

How will we deliver through the taskforce a clear action plan that will make a difference? We will bring together the national recommendations from this review and the independent review from my noble friend Lady Amos, rightly established by the former Secretary of State, which will report this Wednesday. The work will also look at previous reviews. It is right to say that there have been many previous reviews and lessons clearly have not been learned, which is totally unacceptable. It will be our duty to deliver that lasting change through the National Maternity and Neonatal Taskforce.

I have some immediate responses to the points raised by noble Lords on the Front Benches. The Secretary of State announced last week that we are extending Martha’s rule straightaway to all maternity and neonatal services. That means that every parent or caring person supporting a birth can request a rapid review from an independent medical team if the condition of a baby or mother is deteriorating and they are concerned that it is not being responded to. This is a very important step on the point of real listening.

I was also absolutely shocked to read the findings on mortuaries. They are chilling and deeply distressing. It is hard to believe that these things could ever be allowed to happen. There is a live police investigation, and two people have recently been arrested—noble Lords will appreciate that I cannot say more. Two immediate actions are also being taken: the Human Tissue Authority is conducting an urgent national review of mortuary incident reporting and NHS England, on instruction from the Secretary of State, is writing to all trusts to ensure that they consider the findings on mortuary care in this report.

I will pick up some of the questions asked by the Front Benches. On the point about boards being accountable for an open culture and patient safety coming first, that is their job. Noble Lords will not be surprised to hear that there has been a change of leadership. This week, the Secretary of State is meeting the chief executive and interim chair to discuss this point. Boards are held accountable to ensure that there is a patient safety culture through strict duties, independent oversight and targeted regulatory assessments. Clearly, this was not the case here and in other areas, but I welcome the change in leadership and their commitment to delivering a change of culture. I am grateful to Donna Ockenden for recognising that there have been improvements, though she is right that more needs to happen. As I said earlier, this is not just one random situation in one area—it goes so much deeper than that.

The noble Lord, Lord Kamall, asked about workforce. One of the recommended actions from the Nottingham report is that a perinatal workforce tool be developed. This will be considered by the taskforce along with all the other recommendations, as we have discussed.

The noble Baroness, Lady Pidgeon, asked about the urgent work to assess the competence of NHS trust boards. For example, the Nottingham trust has a learning and improvement board to oversee the required improvements, chaired by Michelle Welsh MP. It is supported by a family board and a staff board, which is the model we need to see.

On strengthening whistleblowing as part of the taskforce’s work, we will be looking at all parts of the health system when things go wrong, including how accountability is established and, if necessary, strengthened. On a maternity rescue package, continuity of care, referred to by the noble Baroness, Lady Pidgeon, is an action in the report from Nottingham and will be considered closely by the taskforce.

The noble Lord, Lord Kamall, asked about sodium valproate compensation. The Patient Safety Commissioner rightly continues to press on that. I do not have a specific update for the noble Lord; as soon as I do, I will be very glad to write to him.

It is impossible not to be affected by this report, but I consider it a luxury that I am affected in how I feel rather than in what has happened to me. Again, I apologise for myself and on behalf of the Government for the harm, losses and trauma that continue to this day. I commit us to doing all we can to make sure this is not repeated, and I am grateful to have the support of the Front Benches in doing this.

[Baroness Chisholm of Owlpen (Non-Afl)]

This is the most appalling thing that has happened. I have great respect for the Minister, and I thank her for letting us know about some of the action plans going ahead. What has gone wrong with a profession where the professionals have seemingly no empathy for those they are caring for? Is this about society? Have we given up putting others first? Have we become a society where we do not listen and do not treat each person as an individual with needs individual to them? That is what I was taught when I was given my nursing training. Is that being taught now? Have we forgotten how we behave towards individuals when they are asking for help? Do we not listen and do everything in our power to make them feel better? Government cannot do everything; it has to be society that can, in some way, teach people in these very important roles how they treat the human beings in front of them.

[Baroness Merron (Lab)]

I certainly agree. Every woman, in the case of maternity services, deserves safe and compassionate maternity care. That is why we are so determined to drive urgent improvements in maternity services. It is worth noting that this review—the largest ever of its kind, as the noble Lord, Lord Kamall, said—considered the experience of more than 2,500 families and 830 staff. I think it is important that your Lordships’ House also remembers how many staff have found themselves in situations they would never have wanted to be in. I am sure that the noble Baroness, like me, pays great tribute to the many NHS staff who are in the majority in doing their work in a compassionate way—as the noble Baroness has experienced.

I cannot comment on whether it is specific to society but, from Donna Ockenden’s conclusions, there was something deeply wrong here. Whether it was not listening, culture or racism and discrimination towards women, families and staff, and between staff, we cannot have it.

[Lord Hunt of Kings Heath (Lab)]

My Lords, to continue this theme, the report describes a bullying and toxic culture, with junior midwives not being sufficiently supported when dealing with complex cases. It was a culture that did not allow them to refer such cases up the chain. There was a constant turnover in senior midwifery leadership and those they appointed were not given proper induction, mentoring or even guidance about their roles. In the work that the Minister is taking forward with the Secretary of State, will there be a concerted national programme of training and development for senior midwives so that there is a real opportunity to try to grip these issues?

[Baroness Merron (Lab)]

My noble friend’s analysis is quite right. One of the reasons we are developing an anti-discrimination programme is that cultural change across maternity and neonatal services is much needed. I use that as one example; all NHS trusts are to have completed that programme by 2027, and that is already under way.

I found it absolutely shocking that so many senior people at Nottingham did not give evidence to Donna Ockenden’s investigation. That is why, once the Hillsborough law Bill receives Royal Assent, we will extend the duty of candour to the Leeds and Sussex reviews so that the chair, Donna Ockenden, will have the powers to find the truth from organisations and staff. On the earlier point, it is quite shocking and totally unacceptable that they refused to participate.

[Baroness Wheatcroft (CB)]

The Ockenden report does a great job in looking at the problems in one specific trust. However, the problems go much deeper, as the Minister has said. It is cultural, and one of the cultural problems appears to be that there is a complete split between a contingent of midwives and the rest of the medical profession about medical intervention. Until that is tackled, I cannot believe that we are going to get to the root of the problem. Will the Minister commit that the taskforce will delve into that difficult issue? It is cultural, but it is a very deep difference of opinion that goes back to the noble Baroness’s question about what has changed. That is part of what has changed.

[Baroness Merron (Lab)]

The key is to bring together the recommendations from Donna Ockenden’s report with the independent report that we established, chaired by my noble friend Lady Amos, which will report on Wednesday, as well as the reviews from before. I do not think we necessarily need a description of the problem but, to the noble Baroness’s point, we do need action to challenge and monitor this. Transparency and accountability will also be our friends, which in Nottingham they were not.

[Baroness Hodgson of Abinger (Con)]

My Lords, as we know, this horrific failure is not confined to Nottingham University Hospitals NHS Trust. A number of other NHS trusts are being investigated, and I suspect it goes much further. Neither is this a problem of just the last 13 years; it goes back decades.

Forty years ago, one of my twin sons died at birth, a combination of bad decisions, inadequate systems and negligence. It was similarly impossible to get answers, with the name of the midwife withheld and the notes disappearing, including the only photo, and no one held accountable. The damage to families from this type of behaviour is unquantifiable. How is the Minister going to change this endemic culture of cover-up in the NHS and ensure that systems are put in place so that when even one baby is put at risk, is damaged or dies, the situation is properly examined so that it cannot happen again?

[Baroness Merron (Lab)]

I am so very sorry to hear of the noble Baroness’s experience; I am grateful to her for sharing it with your Lordships’ House. I am sure we all offer our condolences and understanding as far as we can to support her and her family, and I say how sorry I am for her loss.

The noble Baroness is right to talk about cover-up. That did happen in this case and has also been identified through other reviews. Certainly, as Donna Ockenden conducts reviews into Leeds and Sussex, we will be able to find out what happened there. But we are not waiting, and I assure the noble Baroness of that.

It is worth speaking about the role of the regulators, because it has come up not by using the word itself but by how account is kept. The Secretary of State is meeting with the GMC—which we currently have a three-month consultation on reforming—because he wants to hear its personal account for failings in care. The Nursing and Midwifery Council has been undergoing a widespread programme of reorganisation and change under new leadership, which, again, is much needed. I assure the noble Baroness that, as part of the taskforce, we are looking at all parts of the health system where things go wrong, including how accountability is established, because we should be avoiding that harm where it is avoidable.

[Baroness Nargund (Lab)]

My Lords, I welcome the report and thank my noble friend the Minister for all the work she is doing with the Secretary of State to support and to implement recommendations. Our thoughts are with the families affected. The report has yet again shown the racial bias in care, which is harming mothers and babies. I request that my noble friend the Minister ensures that cultural competency training is integrated in medical school and in midwives’ training, so that they are qualified after receiving that training and it is not left for later.

[Baroness Merron (Lab)]

It is absolutely crucial, as my noble friend says, that the training should reflect the needs of the care that will be given. That is something that I know the taskforce will look at very closely. Donna Ockenden’s report offers insight and recommendations on workforce and training. The noble Baroness, Lady Amos, may also do so. I mentioned the anti-discrimination programme, but I should also say, on inequalities, that we have launched a maternal care bundle on what the best practice is for clinical conditions that are the leading causes of death for women from Black and Asian backgrounds. As I say, the numbers reflect a great inequality which cannot be allowed to continue.

[Baroness Berridge (Con)]

My Lords, building on the Minister’s comments on the maternal care bundle, which was introduced because Black women are 2.3 times more likely to die in childbirth, this report also confirms that, in Nottingham and Nottinghamshire, infant mortality rates were significantly higher for Black and Asian women. In the report, a full dataset is not given of women of ethnicity. Can she also reflect on the recommendations from the Preterm Birth Select Committee report that we need more nuanced recommendations in this regard, and more work on causality? It is not clear, from what I have read in the report, why there is a 2.3 times greater likelihood that these women die; we need more work on that as well.

[Baroness Merron (Lab)]

The noble Baroness is right to refer to the report undertaken by the Lords committee, which I was pleased to be invited to appear before. It is true that there is a complexity. Outcomes also vary between trusts. There are a lot of potential reasons, but “potential” is not good enough. In 2023, the number of stillbirths in the most deprived areas remained much higher than in the least deprived.

In all the ways that noble Lords, including the noble Baroness, have mentioned, there are deep inequalities. NHS England has published an inequalities dashboard. That is important because it supports the identification of areas where populations face the greatest disparity, so that interventions can be appropriate for them and there can be more equitable support. We will certainly look very carefully at the differences and the inequalities, because that will be a real driver for change.

[Lord Roe of West Wickham (Lab)]

My Lords, I thank my noble friend the Minister and the Secretary of State for their hard work, shining a light on the inadequacies in maternity services in this country. My question is more general. The Minister referred to the coming Hillsborough law—one would hope in the next Session—which will be vital to accountability and driving candour across reviews into areas of both public and private failure. I respectfully ask, if the Minister cannot update me on progress being made on an oversight mechanism, whether the relevant Cabinet Office Minister might write to me to provide an update on progress. I am afraid that without the addition of an oversight mechanism, whether through a powerful public committee set up within Parliament or an independent body, we will once again return to terrible stories, whether in maternity, construction or other aspects of care.

[Baroness Merron (Lab)]

I will be pleased to raise that with my ministerial colleague in the Cabinet Office. I agree that an oversight mechanism is very important. On the Bill—which will, of course, become an Act—it is key to note that it will establish a new duty of candour and assistance at inquiries, inquests and other investigations. To the point that we are discussing here, the Bill will also allow for that duty of candour to be applied to health investigations by regulation. That is crucial, and it is by using that power that we will ensure that the Leeds and Sussex reviews, which are live, are included through secondary legislation.

[Baroness Manzoor (Con)]

My Lords, I align myself with the comments that have been made by the noble Lord, Lord Kamall, and the noble Baroness, Lady Pidgeon. This a totally devastating outcome. I pay tribute to the families that have been affected in this way.

I am just absolutely disturbed by the quality of the governance at the trust. I am shocked. I have chaired a number of trusts. To not put patient safety first and to not have the data available to make that judgment is absolutely appalling. Therefore, in terms of accountability, will the Minister assure me that the chief executive, the chair or, indeed, any members of the board who have been given honours as a result of their service to their trust are stripped of them? It is not an honour; it is absolutely devastating, and there has been a lack of duty in what they have achieved.

[Baroness Merron (Lab)]

I completely understand the noble Baroness’s point. I am grateful for her sensitivity on this subject. I do not feel qualified to comment on honours and their removal, but I will raise it with the appropriate ministerial colleague to say that this is a view—exactly as the noble Baroness said. I know that she is not alone in feeling that.

[Lord Beamish (Lab)]

My Lords, this is an appalling case, but some of the themes in it are common to other scandals, including the Post Office scandal: people being ignored, people not knowing how to complain and the system basically coming together to protect itself rather than representing and identifying failings. I accept that the Hillsborough Bill will be a step forward, but we also need a cultural change, and I stress that one of the issues is the GMC. Self-regulation has to go. It is about time that doctors were held to account, because anyone who has tried to complain about a medical situation through the GMC finds that it is labyrinthine and slow, and does not put the patient at the centre.

[Baroness Merron (Lab)]

My noble friend is right to draw comparisons and, as I said earlier, I certainly agree on the point about culture that is made very clearly in the report from Donna Ockenden. I will be looking very closely at that also in the recommendations of my noble friend Lady Amos. As I said earlier, we have sought to make change. I do also think that accountability and transparency are absolutely key. It is one thing to seek to make change, but another for people to feel confident and to know it has happened.

[Baroness Shawcross-Wolfson (Con)]

I am grateful to the noble Baroness for her eloquent and moving statement and her commitment to taking action on this. The noble Baroness said that the workforce planning recommendations from the Ockenden review and potentially also from the Amos review will be picked up in the maternity taskforce action plan, due at the end of the year. Can she tell us how that will fit with the upcoming wider NHS 10-year workforce plan? Will the wider 10-year workforce plan also look at the staffing and training needed for safer maternity services, and can she confirm when it will be published?

[Baroness Merron (Lab)]

We are soon expecting the 10-year workforce plan. In its considerations, it will address patient safety, because that is one of the requirements when thinking about workforce. But the really close look in the way the noble Baroness seeks will be through the plan which the taskforce is overseeing, having received the recommendations. It is the case that maternity services, for a whole range of reasons, including the absolutely shocking experiences that we have all referred to, have suffered in some areas because of a lack of safety, a lack of listening, and the wrong kind of culture and leadership—the list goes on. I know that noble Lords will have looked at the report and I would want to ensure that maternity services have their particular focus, in order that what I believe will be a credible plan by the end of the year will take account of the very points that the noble Baroness rightly makes.

Foetal Alcohol Spectrum Disorder

Baroness Merron Excerpts

Thursday 25th June 2026 Lords Chamber

[Baroness Hyde of Bemerton]

To ask His Majesty’s Government what steps they are taking to improve awareness and reduce the prevalence of foetal alcohol spectrum disorder.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, we continue to promote the advice of the Chief Medical Officers in the UK that pregnant women or those planning a pregnancy should avoid alcohol, alongside promoting the NICE quality standards on FASD. We are committed to ensuring that all pregnant women with alcohol problems are supported to reduce the risk of harm to them and the foetus. This includes providing local authorities, through the public health grant, with £3.4 billion of funding for alcohol and drug treatment and recovery over the next three years.

[Baroness Hyde of Bemerton (Lab)]

Labour Governments have a hugely successful track record of improving the health of the population, for example, reducing smoking in public places and the recent range of measures in the Tobacco and Vapes Act. Research evidence suggests that the impact of drinking alcohol in pregnancy—any amount of alcohol—may be comparable or greater than the risks of smoking. Therefore, would the Minister undertake to review all opportunities for enhancing prevention, such as adding foetal alcohol spectrum disorder prevention measures to the recent women’s health strategy, strategies for sexual and reproductive health and the interim mental health strategy? Will she also work with colleagues to ensure that FASD education and prevention is a policy priority for local authority health teams?

[Baroness Merron (Lab)]

My noble friend is quite right. There are tremendous opportunities to link up work on tackling foetal alcohol spectrum disorder with other parts of our work, not least the major principle of moving from treatment of sickness to prevention. I assure my noble friend that we are working across government. We will also continue to work with all local areas so that we can address unmet need, prioritise prevention and make sure that we have improvements to alcohol treatment services. All of these will make a difference.

[Baroness Walmsley (LD)]

My Lords, according to the association for FASD, every prevented case saves over £400,000 in lifetime costs, as well as the personal tragedy. Universal antenatal alcohol history taking is recommended by NICE guidelines, but implementation remains variable. Will the Government embed NICE guidelines everywhere, alongside a national public health campaign on alcohol in pregnancy, equivalent to the effective existing smoking in pregnancy campaign?

[Baroness Merron (Lab)]

In addition to the ring-fenced funding I spoke of, we are going further on alcohol labels to get across the important points. In 2022, NICE produced and published a quality standard, which the noble Baroness referred to, so that the system can help diagnose but also support those affected by FASD. I am not aware of there being widespread difficulties with its adoption, because it is so fundamental to pre-pregnancy and pregnancy care, but, if the noble Baroness has particular examples, I would of course be pleased to look into them.

[Baroness Finlay of Llandaff (CB)]

My Lords, the Government’s initiatives on alcohol prevention in pregnancy are to be welcomed and are very impressive, but can the Minister assure us that the industry itself will not be involved in consultations and in designing public health programmes? To date, the tiny pictograms on bottles, particularly of wine and other alcohol products, are so small that they are ineffective. We really need consistent messaging in a much broader sphere where people eat out, drink out and socialise, and in all public health measures.

[Baroness Merron (Lab)]

I take the noble Baroness’s point, which is why I am glad that we committed in the 10-year health plan to making it a legal requirement—therefore strengthening it—that alcohol labels display health warnings and consistent nutritional information. That is something else that noble Lords have raised. As was referred to in the previous question, it is also important that we note that part of care for pregnant women is dealing with alcohol consumption.

[Baroness Nargund (Lab)]

My Lords, no amount of alcohol is considered to be safe in pregnancy. Foetal alcohol spectrum disorder—FASD—affects roughly one child in every classroom of 25 children, and it is a preventable neurodevelopmental disorder. A report published just two days ago by the National Organisation for FASD suggests that inaction in addressing this problem is costing the UK economy £9.2 billion annually. As most people in the UK drink alcohol, and as nearly half of pregnancies are unplanned and one-third of births are unplanned or associated with feelings of ambivalence, I ask my noble friend the Minister: do the Government have any plans to extend the public health campaign to pre-conception clinics and to advise women who are planning to get pregnant? That requires pre-conception advice, as so many pregnancies are unplanned. Will the Government also link that to school education, please?

[Baroness Merron (Lab)]

My noble friend is quite right about the potentially lasting effects of foetal alcohol spectrum disorder on children, which is why the main priority is preventing it. There are three approaches. First, the clear advice—the safest approach, if you are pregnant or could become pregnant—is not to drink alcohol, and that will remain consistent. I have just referred to the legal requirement for alcohol labels. We will of course continue to look at how prevention messaging can best reach people pre conception. The obvious point here is that so many pregnancies are not planned, so there is no neat solution to getting to the right people. We have to get our messaging right, which is why we are taking the approach we are.

[Lord Evans of Rainow (Con)]

My Lords, the Department of Health and Social Care’s own health needs assessment noted that there are still no reliable prevalence studies for foetal alcohol spectrum disorder in England, despite estimates suggesting that the UK may have one of the highest rates in Europe. How can the Government effectively reduce the prevalence of foetal alcohol spectrum disorder when they still do not know with confidence how many children and adults are living with the condition? What steps have the Government taken to improve diagnosis and data collection?

[Baroness Merron (Lab)]

The noble Lord is quite right that we are working on estimates, and there are a number of practical reasons for that. To come to the noble Lord’s real point, the first National Institute for Health and Care Research challenge funding call was launched in 2024, backed by £50 million. That tasked researchers and policymakers with finding new ways to tackle maternity disparities and poor pregnancy outcomes, and clearly that will support further research and policy. So we are looking to the future and I take on that challenge; it is one that we are meeting.

[Baroness Hollins (CB)]

My Lords, of course prevention is important, but does the noble Baroness agree that children with foetal alcohol spectrum disorder need continuing specialist education and support throughout life, as do their families, many of whom of course are adoptive families?

[Baroness Merron (Lab)]

The noble Baroness is quite right. This is one of the many reasons that I am enthusiastic, as we move towards the single patient record. We will absolutely ensure that carers and parents—however families are formed, because of course they are formed in different ways—are part of our consideration. The noble Baroness is absolutely right about that.

[Baroness Hayter of Kentish Town (Lab)]

As my noble friend said, this is important before people become pregnant. Many people who become pregnant are of course young women, but so much of the advertising by the alcohol industry is aimed at exactly those youngsters. Although I take the point from the noble Baroness, Lady Finlay, about not involving the industry in the solutions, I do think that the Government should talk about advertising that is not aimed at young women, because they are exactly the ones who might become pregnant.

[Baroness Merron (Lab)]

On the matter of advertising, particularly when we think about other areas as well, we work on the basis that we are not banning alcohol use: I absolutely know that my noble friend is not asking for that. I am sure that would not be popular in your Lordships’ House, so it is probably good that I put it on record. However, what matters is that we are all equipped to make the right health decisions and are actively supported, not just through information. Industry has a role to play in promoting responsible drinking, which is important in pregnancy and in general terms as well. It is one of the health risks that we need to tackle. As we move to create the healthiest generation ever, our work on alcohol as well as tobacco and obesity is absolutely key.

Healthcare Services: Acute, Primary and Community

Baroness Merron Excerpts

Thursday 25th June 2026 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I congratulate the noble Baroness, Lady Janke, on securing a very important debate. I am also grateful to all noble Lords for their contributions. I recognise many of the challenges raised, which is exactly why we are taking the action that we are. I am glad that the noble Lord, Lord Evans, in particular welcomed the direction of movement, as have so many noble Lords, including the noble Baroness, Lady Pidgeon.

It is important that we look at where we started, because I think it reminds us of the scale of the challenge. It was the noble Lord, Lord Darzi, who made the point that we inherited an NHS facing the worst crisis in its history. We all know of people stuck on waiting lists for many years, staff who have felt let down by bureaucracy and little support, and patients who have had to navigate a system that all too often felt complex, disjointed and fragmented—the noble Baroness, Lady Brinton, spoke about literal navigation, which I thought was a key point. Not only was that the situation but we recognise that, while we are making improvements, there is some way to go, and I want to set that out at the outset.

I am grateful to the noble Baroness, Lady Lane-Fox, for talking of her own personal experience, and I can say to her that, yes, the patient is at the centre of all the reforms that we are making.

The noble Lord, Lord Darzi, found that society is getting sicker. People are living longer but in poorer health and with more complex needs. I should emphasise that that burden is not shared equally. The gap in healthy life expectancy has grown between the richest and poorest areas, and the model of care that was in place, which we are still seeking to change, while making progress, is working least well for those with greatest disadvantage, who are most likely to have complex needs. I agree that the system we inherited and are changing has been too hospital-centric, too detached from communities and too organised into silos. To the noble Baroness, Lady Lane-Fox, I say, yes, modern technology has transformed everyday life, and the scale of change certainly had not reached the National Health Service. We had a stark choice, as noble Lords know, and our response is reform

We also heard from staff and patients that they do not want the status quo. To agree with the noble Lord, Lord Scriven, people said that they wanted radical reform, and we have embraced that. I believe that the 10-year health plan responds to that, setting out the three fundamental shifts—hospital to community, analogue to digital, and sickness to prevention—with neighbourhood health at its very core. Our neighbourhood health framework, which was published in March, gives partners the clarity to develop locally led plans.

What is at the core of this debate is how to make that shift real. For the first time, the medium-term planning framework sets a target to reduce long waits in community health services, with at least 80% of activity to take place within 18 weeks by 2028-29. We are restoring GP access; to some of the points made about the important role, which we acknowledge, of the GP, more than 76% of people are now saying that it is easy to contact their GP, which is up from 61% when we came into office.

The noble Baronesses, Lady Brinton and Lady Gerada, and the noble Lord, Lord Scriven, all spoke of the importance of GPs. We are training thousands more GPs, and we are boosting capacity. From July 2024 to April 2026, we had more than 2,000 additional GPs; in total, we now have over 30,000, which is the highest number since 2015. This has meant that we have delivered 12.7 million additional GP appointments this year compared with last year, and I am grateful to GPs.

We are investing directly in the services that will make neighbourhood health possible, which was raised, quite rightly, by the noble Baroness, Lady Cass. I totally agree with her about young people having that voice, and we ensure that that is the case, but I know where to come should we need further assistance.

We have invested an additional £601 million in general practice, taking total GP contract investment to nearly £14 billion in 2026-27. A number of noble Lords, including the noble Baronesses, Lady Janke and Lady Leaman, spoke about the importance of community pharmacy, which I totally align myself with. That is why, to recognise that key role, we have given a 10% uplift, which translates to £340 million. Further on funding, as a number of noble Lords have raised, including the noble Lord, Lord Scriven, over £9 billion is being invested through the better care fund, and there is a commitment to deliver 250 neighbourhood health centres, for which the first 27 sites have already been selected.

This is not just a vision, but vision is important: one of continuous, accessible and integrated care, centred around the patient, which prevents ill health, intervenes earlier and gives people more control, by 2035. I understand the wish for pace, and I share it, but we also have to be realistic. There is a reason it is a 10-year health plan: it is not so we wait but so we have a plan that will transform the model of elective care.

Many interactions will no longer take place in a hospital building, but they will be able to take place. The noble Baroness, Lady Lane-Fox, asked whether we are using technology to the best advantage; the NHS was certainly way behind where it should have been, but we are moving towards that, because interactions will be able to take place virtually or through neighbourhood services closer to home. We will see the first NHS online hospital, the development of the NHS app—which has already greatly improved, as many of us know, as patients access care, information and appointments more responsively through their phones—and, by 2035, two-thirds of out-patient care will take place digitally or in the community. Central to that will be the single patient record, which I look forward to coming to when we receive the Health Bill.

General practice will remain at the heart of neighbourhood health. I heard what the noble Baroness, Lady Gerada, said. We are introducing two new at-scale contracts—the single neighbourhood provider and the multi-neighbourhood provider—to support GPs and partners to work against larger geographies. I recognise the pressure on GPs. We are working with GPs to assist them in their effectiveness and in the way in which they serve patients. Integrated health organisations will take responsibility for local population budgets. They will support integration and move resources to where they have the greatest impact.

Key within this debate, and raised in particular by the noble Baronesses, Lady Pidgeon and Lady Gerada, the noble Lord, Lord Scriven, and other noble Lords, is funding. We know the importance of ensuring that investment supports the shift from hospitals to communities—and I say to the noble Lord, Lord Evans, that that will include mental health as well as primary care and neighbourhood care. The 10-year health plan sets out an operating model that shifts power from the centre to local commissioners and providers. As I mentioned, ICBs and providers are developing medium-term and multiyear plans through the medium-term planning framework to show how they will use funding in line with the priorities.

I assure noble Lords that ICB allocations give greater growth to community rather than acute services to support the community transformation that noble Lords and I seek and to support neighbourhood health. We will continue to set those national expectations, and we will support that by changes to system incentives, such as financial flows. I hear the call for ring-fences, which is often made. It is a legitimate challenge, but they do not by themselves guarantee better outcomes. Our approach is to set national priorities and accountability, as well as enabling ICBs to use funding flexibly, because they are best placed, as we know, to meet local need and secure best value.

[Lord Scriven (LD)]

My point was that flexibility is taken away when national directives come down, forcing ICBs to spend money on acute and emergency care.

[Baroness Merron (Lab)]

I always appreciate the expertise of the noble Lord, but I have set out our approach. We are focusing on outcomes and the best way to achieve them. We keep them constantly under review and discussion, so it is not top-down but how we are going to get to the place that all noble Lords want us to get to.

I know that I will be able to refer to only a limited number of questions, and I hope noble Lords will forgive me. The noble Baroness, Lady Walmsley, raised dental deserts. We are offering incentives to attract dentists under the golden hello scheme, which is what it says on the tin. Importantly, we are also increasing the supply of dentists. We have just announced the first sustained expansion of dental school places since 2007. The noble Baroness, Lady Walmsley, also asked about progress being made on publishing health food standards and the consultation. I acknowledge her particular interest and expertise. We will soon be consulting on the proposals for healthier foods targets and reporting. Importantly, we remain on track for delivering on this 10-year health plan commitment in this Parliament. If the noble Baroness would like further information, I would be very happy to obtain it for her.

The noble Lord, Lord Evans, asked about milestones that will be used to ensure that the shift from hospital to community is taking place, which is important. That is why we have published the Neighbourhood Health Framework, which will ensure that accountability. I am very alive to the points he made about mental health services, and I am sure that he welcomes the mental health strategy that will bring together all the points. I am very enthusiastic about the fact that we are piloting community-based mental health centres. I was glad to visit the one in Birmingham, which totally persuaded me of their value, but we must of course wait for the evidence.

I know that noble Lords know that the NHS that we inherited was under intolerable pressure. We have chosen reform, we have invested, we are rebuilding access, we are enhancing digital tools and we will deliver an NHS closer to home that is more preventive, joined-up and equal. That is the way we will take the NHS into the future.

Puberty Blockers Trial: Consent

Baroness Merron Excerpts

Thursday 25th June 2026 Lords Chamber

[Baroness Deech (CB)]

My Lords, in begging leave to ask the Question standing in my name on the Order Paper, I declare an interest as former chair of the Human Fertilisation and Embryology Authority.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, the PATHWAYS trial entry age was recently reviewed by the MHRA and the sponsor, resulting in a minimum age of 11 for females and 12 for males. It aims to study treatment when it is most clinically relevant while safeguarding participants. Eligibility is tightly controlled; it requires parental consent, a minimum two-year gender incongruence diagnosis, psychosocial support, and NHS and multidisciplinary team approval, as well as participant understanding of the risks and benefits, physical and mental stability, and compliance with safeguarding requirements.

[Baroness Deech (CB)]

My Lords, how can the Minister justify the age of 11 for a puberty blocker trial? A child under 16 cannot consent to sex or to medical treatment if they are not Gillick competent. They cannot join the Army, smoke, take drugs or alcohol, or even watch social media soon. We condemn FGM, but here is something much more profound. I ask your Lordships to think back to when you were 11—did you understand what it meant to be a woman or a man? The children in this trial are utterly unable to give meaningful consent.

A trial of just two years will tell us nothing. We need retrospective evidence from those who have already taken these drugs. It is only when they reach middle age that those experimented-on children might reflect on whether it would have been better to have been fertile, to have had fulfilling, intimate relationships and to have been themselves. I predict litigation on the scale of infected blood. The first principle of medical ethics is, “Do no harm”. This trial cannot avoid doing harm. I think parents will join me in asking the Minister to stop it.

[Baroness Merron (Lab)]

I appreciate that the noble Baroness has strong views—so do a number of noble Lords, as we heard on the Statement that I presented and responded to yesterday. On consent, I remind noble Lords that this is a sensitive, emotive and difficult subject, but that is why we have to be driven, as the previous Government were, by clinical evidence and experts. I recall that the noble Baroness, Lady Cass, who was rightly entrusted with an independent review, said:

“This is an area of remarkably weak evidence”.


There are always choices. We could continue with uncertainty and risks to the safety of children and young people, which I think none of us wants, or undertake a scientifically guided trial for 233 children, with all the right safeguards that I have referred to, and protect children and young people.

[Baroness Chakrabarti (Lab)]

My Lords, am I right that these drugs are also sometimes necessarily available to quite young people who might otherwise go into premature puberty, with serious health results? With gender dysphoria, is it not better that we look into the possible use of these drugs rather than have children and young people fixate on surgery, which is much harder to stop or reverse?

[Baroness Merron (Lab)]

My noble friend is quite right about the use of these drugs. It is important to note that we banned their use indefinitely for gender dysphoria outside of research settings because of the immense concerns about safety. That ban has been in place since January 2025. She is also right that the issue will not go away. The right way to protect children, as I have said, is to act on clinical evidence and opinion, and to make that decision with a cool head. That is why, despite the difficulty of such a decision, the Secretary of State has made it. He is doing the best he can to protect children in this situation.

[Baroness Cass (CB)]

My Lords—

--- Later in debate ---

[Lord Scriven (LD)]

My Lords, the review from the noble Baroness, Lady Cass, warned that having no formal medical routes risks driving families towards unregulated online pharmacies and private clinics abroad. Given that an indefinite pause of the trial left some highly vulnerable young people in a state of clinical limbo, does the Minister agree that getting an evidence-gathering trial under way would be an effective way to protect them from the dangers of these unregulated and unmonitored markets?

[Baroness Merron (Lab)]

I certainly do agree. As I have said, having put a ban in place, we will take action against those who seek to transgress and benefit from it by seeking to sell drugs that are not permitted. That is a totally unacceptable route for them to follow. They risk the safety and well-being of children.

[Baroness Cash (Con)]

My Lords, yesterday the Minister told the House that the PATHWAYS trial would be covered by insurance. I have been unable to identify any insurance company that will cover such treatment, even in a trial setting, so can she tell us how insurance has been obtained, the information on which it is based and from which provider it has been obtained? I appreciate that this may not be possible in the Chamber due to time, but I would be grateful to see the information provided in detail and the terms of the policy.

[Baroness Merron (Lab)]

Although I am keen to be helpful to the noble Baroness, my comments yesterday related to trials and insurance provisions. I do not know what research has been undertaken since then. I would be pleased to write to her; I cannot promise the detail she seeks, but I will seek to be helpful.

[Baroness Cass (CB)]

My Lords, I have spoken to my clinical colleagues about the issue of age at enrolment and they expect enrolment at 11 or 12 to be vanishingly rare. However, I ask noble Lords to consider the case of a child I will call Jo, who was a biological male socially transitioned at two and a half by his parents. At 11, she—I say this advisedly, because the chances of her reverting to her biological gender are vanishingly remote—has been in stealth and will not go to secondary school because she is so afraid of being outed in that environment. She is now refusing to come out of her room except very rarely and has weak bones, not as a result of puberty blockers but through inactivity. Should her subsequent treatment be decided by politicians or by the clinicians looking after her?

[Baroness Merron (Lab)]

The noble Baroness brings her expertise to the subject and I am grateful to her. This is not a political matter. As I have said, it must be driven by clinical evidence and focus on the safety of our young people. The example she gave is deeply disturbing and is a result of not taking action that is evidenced.

[Lord Cashman (Non-Afl)]

My Lords, the only thing that matters in this instance is the right of the child to the best and most appropriate treatment. Therefore, does the Minister agree that puberty blockers are used for a range of conditions and that any approach must therefore be based solely on the recommendations of the multidisciplinary team, the clinicians involved and the needs of the patient?

[Baroness Merron (Lab)]

Yes, it is certainly the case that this is a medical matter. We need to remind ourselves, and my noble friend gives me that opportunity, that puberty blockers, as we are calling them, are used for other conditions, but the reason why we are having the trial is because we have accepted the advice and acted on the principles that my noble friend has outlined.

[The Lord Bishop of Manchester]

Would the Minister agree that the scientific trials are the best way to try to remove this from the culture wars that are so damning this particular topic?

[Baroness Merron (Lab)]

I am very glad to agree with the right reverend Prelate. As I said earlier, it is very important to have a cool head, to be evidence-based and to not politicise this. This is too important to take those risks.